Compliance with anti-tuberculous therapy: a field trial of a pill-box with a concealed electronic recording device

Abstract

We have conducted a field trial of a pill-box containing a concealed electronic device for monitoring compliance in 23 consecutive adult out patients taking a rifampicin/isoniazid combination once daily. In 22 cases, the times when the box was opened were successfully recorded for the entire period (mean (SD) 26 (5) days) between successive clinic visits. In the other patient the record terminated after one week, a broken box being returned. Both totality of compliance (as assessed by box openings) and consistency of compliance (the proportion of the total number of intervals between openings which were of 22 to 26 h in length) were significantly greater in those studied in the intensive than in the maintenance phase of therapy. Patients may have taken the reduction in medication at the end of the intensive phase as signalling cure. A computer program has been developed to display the recorded data. This allowed the physician responsible to assimilate at a glance the patient's tablet-taking habits. In routine practice knowledge of the presence of the device may improve compliance and a discussion of the graphical display may prove of value in counselling.

Serum Concentration Monitoring of Cardiac Glycosides

“…Clin. The monitored pill box has been used in routine follow-up (Cheung et al 1988a) and in clinical trials (e.g. 20 (3) 1991 The patient's tablet-taking habits can be monitored by an electronic device coupled to the tablet container, which records when the latter is opened and/ or when doses are removed.…”

Variable patient compliance in ambulatory trials—nuisance, threat, opportunity

“…One involves labelling of drugs with an inactive, low-dose chemical marker such as digoxin or phenobarbitone (Feely et al, 1987); the latter has had widest usage (Pullar & Feely, 1990). In the other new method, time-recording microcircuitry, is inserted into various types of drug packaging and time and date of removal of the drug are recorded by means of microswitches or optical sensors when a package is opened and closed, or, in some designs, when a dose is removed (Kass et al, 19866;Eisen et al, 1987;Cheung et al, 1988;Cramer et al, 1989;Potter 1991;Tashkin et al, 1991).…”

Tuberculosis in the AIDS era

“…Treatment noncompliance, the major cause of secondary resistance of tuberculosis, is common, with at least 20% of patients who start antituberculous regimens failing to complete the course within 12 months (3,14,136,326). Many tricks to improve compliance have been tried (68). One method to ensure patient compliance is with directly observed therapy (DOT), wherein an observer dispenses medicine and then watches a specific patient take the pills.…”